Fernández Pineda L, Maître Azcárate M J, López Zea M, Rico Gómez F, Cazzaniga Bullón M, Quero Jiménez M
Servicio de Cardiología Pediátrica, Hospital Ramón y Cajal, Madrid.
Rev Esp Cardiol. 1995 Aug;48(8):537-41.
Aneurysm of the atrial septum at the level of the foramen ovale is reported commonly at the routine fetal echocardiographic examination. Cases with entire involvement of the atrial septum have been exceptionally reported. We described the data concerning the prenatal detection of a total redundancy of the atrial septum in 6 cases without congenital heart disease.
The gestational age was between 28 and 38 weeks, and none of the fetuses had evidence of heart defect. A routine fetal echocardiography was made in all the cases. Rhythm disturbances were studied by M mode. During the first three months of life, a cardiologic control was made in all the cases.
The large displacement of the atrial septum towards the left atrium was clearly visualized in four-chambers view; by using Pulsed Doppler and Color flow mapping, the pulmonary venous return and mitral orifice flow were not impaired. Premature atrial beats were found in two fetuses and no hemodynamic disfunction was observed in all entire study group. Postnatal echocardiographic control was normal in all patients. The atrial septum becomes completely rectified with normal patency of the foramen ovale membrane in the newborn studies. The supraventricular extrasystoles were confirmed in the neonatal period. In both, the arrhythmia disappeared in a few days after delivery without treatment.
Despite the benign follow-up in our cases, the unexpected presence of an extremely redundant atrial septum, leads to a close prenatal attention particularly in the presence of rhythm disturbance. The pathologic substrate of this anomaly might be an intrinsic alteration of the myocardial structure of the septum like seems demonstrated in the aneurysm circumscribed to area of the fossa ovalis [correction of fosa ovale]. The increase in the left atrial pressure after birth will produce a normal 2-D echo patterns in the newborn period.
卵圆孔水平的房间隔瘤在常规胎儿超声心动图检查中较为常见。曾有个别病例报告房间隔完全受累。我们描述了6例无先天性心脏病的胎儿产前检测到房间隔完全冗余的数据。
孕周在28至38周之间，所有胎儿均无心脏缺陷证据。所有病例均进行了常规胎儿超声心动图检查。通过M型超声研究心律失常情况。在出生后的前三个月，对所有病例进行了心脏检查。
在四腔心切面可清晰看到房间隔明显向左心房移位；使用脉冲多普勒和彩色血流图检查发现，肺静脉回流和二尖瓣口血流未受影响。在两个胎儿中发现了房性早搏，整个研究组均未观察到血流动力学功能障碍。所有患者产后超声心动图检查均正常。在新生儿研究中，房间隔完全恢复正常，卵圆孔膜通畅。在新生儿期证实存在室上性早搏。两者在出生后数天未经治疗心律失常均消失。
尽管我们的病例随访结果良好，但房间隔极度冗余的意外出现仍需在产前密切关注，尤其是在存在心律失常的情况下。这种异常的病理基础可能是房间隔心肌结构的内在改变，就像局限于卵圆窝区域的动脉瘤所显示的那样[卵圆窝的校正]。出生后左心房压力升高将在新生儿期产生正常的二维超声心动图表现。
